Linitis plastica

Linitis plastica is a descriptive term usually referring to the appearance of the stomach, although the rectum can also be described this way (see: linitis plastica of the rectum). The appearance is said to be reminiscent of an old leather water-bottle.

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Pathology

The underlying cause is usually a scirrhous adenocarcinoma with diffuse submucosal infiltration, leading to thickening and rigidity to the stomach wall 2.

It is important to realise that as the infiltration is submucosal, gastric biopsies are frequently negative 2.

Radiographic features

Fluoroscopy

During a barium meal, the stomach cannot be adequately distended due to the increased rigidity of the wall with only a narrow lumen identified. The normal mucosal fold pattern is absent, either distorted, thickened or nodular 2.

CT

Typically the stomach is diffusely thickened with a small lumen. Evidence of nodal involvement or widespread metastatic disease should also be sought.

Differential diagnosis

Whether you define linitis plastica as only the appearance of the stomach, irrespective of cause or use it only in the setting of infiltrating adenocarcinoma of the stomach is up to you, but be aware that there does not appear to be general agreement. Thus the cause of linitis plastica are also the differential, and include 4,5: